Presentation
Chronic headache not relieved by analgesics.
Patient Data
Sizable extra-axial dural-based ovoid soft tissue mass lesion at the left parafalcine-high parietal convexity region. It measures approximately 6 x 4.8 x 3.2 (AP x SS x CC) cm and exhibits intermediate T1 signal and intermediate-to-faintly bright T2 signal. It shows homogeneous intense enhancement with large enhancing dural tails in the post-contrast study, as well as thickened adjacent falx cerebri. It invades the superior sagittal sinus which appears obliterated. Associated mass effect in the form of effacement of the underlying cerebral cortical sulci and cortical buckling.
The overlying high parietal bone is markedly thickened and sclerosed with associated extra-osseous small subgaleal soft tissue thickening.
Case Discussion
This is a case of a typical appearance of parafalcine meningioma with an overlying osseous reaction (hyperostosis versus meningioma en plaque) with dural venous sinus invasion.
Different classifications of sinus invasion have been proposed by different authors. For surgical purposes, Sindou and Alvernia developed a simplified classification 1, as follows:
Type I, meningioma attached to the outer layer of the sinus wall; type II, lateral recess invaded; type III, ipsilateral wall invaded; type IV, both ipsilateral wall and roof invaded; type V, sinus totally occluded but contralateral wall free of invasion; type VI, sinus totally invaded, including all three walls.
So, according to the above classification, this case can be classified as grade VI superior sagittal sinus invasion.
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